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154 Cards in this Set
- Front
- Back
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Parasympathetic nerves have long/short preganglionic fibers and release ______(Transmitter) in the ganglia
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long
ACH |
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Parasympathetic activity would increase/decrease heart rate, increase/ decrease gastric motility, contract/relax ciliary muscle, contract/relax bladder sphincter
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decrease
increase contract relax |
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The enzyme which makes ACH is: _________
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Choline acetyl transferase
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The second messenger for M1,M3 and M5 receptors is _______
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IP3 and DAG
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List two therapeutic uses for Indirect cholinergic agonists: _________
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Stimulate bladder , Glaucoma, Alzheimer’s disease, Myasthenia gravis, Anticholinergic poisoning
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List 4 of the major toxicities seen with direct cholinergic agonists: _____________
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Salivation
Lacrimation Urination Defecation |
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Direct nicotinic and muscarinic agonist
A = Bethanechol B = Carbachol C = Donepezil D = Mecamylamine E = Physostigmine F = Succinylcholine G = Tolterodine |
B = Carbachol
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Used exclusively in Alzheimer’s disease
A = Bethanechol B = Carbachol C = Donepezil D = Mecamylamine E = Physostigmine F = Succinylcholine G = Tolterodine |
C = Donepezil
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Nicotinic neuronal antagonist
A = Bethanechol B = Carbachol C = Donepezil D = Mecamylamine E = Physostigmine F = Succinylcholine G = Tolterodine |
D = Mecamylamine
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Depolarizing nicotinic blocker
A = Bethanechol B = Carbachol C = Donepezil D = Mecamylamine E = Physostigmine F = Succinylcholine G = Tolterodine |
F = Succinylcholine
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Parasympathetic nerves have long/short postganglionic fibers and release ________(Transmitter) at the terminal
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short
Ach |
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Parasympathetic activity would increase/decrease salivation, increase/decrease gastric secretions, contract/relax circular muscle in eye, contract/relax bladder.
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increase
increase contract contract |
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The rate limiting step in ACH synthesis is _________.
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choline uptake
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The second messenger for M2 and M4 receptors is __________.
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Decrease cAMP
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List two therapeutic uses for Direct cholinergic agonists: __________
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stimulate bladder
stimulate GI after surgery glaucoma xerostermia |
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List 4 of the major toxicities seen with direct cholinergic agonists: ___________
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salivation,
Lacrimation, urination, defication |
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Muscarinic antagonist used in bradycardia
A = Atropine B = d-tubodurarine C = Neostigmine D = Mecamylamine E = Oxybutynin F = Pilocarpine G = Rivastigmine |
A = Atropine
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Used exclusively in Alzheimer’s disease
A = Atropine B = d-tubodurarine C = Neostigmine D = Mecamylamine E = Oxybutynin F = Pilocarpine G = Rivastigmine |
G = Rivastigmine
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Used in Urinary incontinence
A = Atropine B = d-tubodurarine C = Neostigmine D = Mecamylamine E = Oxybutynin F = Pilocarpine G = Rivastigmine |
E = Oxybutynin
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Non-depolarizing nicotinic blocker
A = Atropine B = d-tubodurarine C = Neostigmine D = Mecamylamine E = Oxybutynin F = Pilocarpine G = Rivastigmine |
B = d-tubodurarine
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Acetylcholinesterase is found in
a) RBCs b) plasma c) liver d) muscle e) skin f) a & c g) a & d h) all of the above |
g) a & d
(also found in nerves, and placenta) |
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Butyrylcholinesterase is found in
a) nerves b) skin c) liver d) RBCs e) placenta f) a & b g) b & c h) all of the above |
g) b & c
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Acetylcholinesterase breaks down ACh in a ______ attachment, releasing ______ & _______.
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2-point
choline & acetate |
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Where are the 2 places of attachment that ACHE breaks ACh at?
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N+ on ACh to the (-) on ACHE
and ester bond on Ach to the histadine-serine residue on ACHE |
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The location of Nm is on __________ and its function is to ___________.
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skeletal muscle
contract muscle |
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Nm and Nn's effects are on _______.
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ion channel
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Nn's location is on ________, and it's function is to _____________.
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location: neural (post-ganglionic neurons)
function: ganglia (post-ganglionic neuron), CNS, adrenal medulla |
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What subtypes of cholinergic receptors have 2nd messengers IP3, DAG, and Gq/11?
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M1, M3, M5
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What are the 2nd messengers and effects of M2 and M4?
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decrease cAMP, Gi, open K+ channels
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Where are M4 and M5 receptors found?
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glands, smooth muscle, CNS
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Where are M2 receptors found?
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atria, neurons/presynaptic, CNS
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Which receptor is found on the CNS, ganglia, and paracrine cells?
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M1
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T/F
M3 receptors are located on glands, smooth muscle, and CNS |
false
not CNS...endothelium (the M5 receptor is located on glands, smooth muscle, and CNS) |
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What is the function of the M5 receptor?
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CNS learning and memory
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T/F
The function of the M4 receptor is CNS, forebrain, autoreceptor, and increases DA release. |
true
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T/F
The function of the M2 receptor is to inhibit the heart, inhibit postsynaptic release, and neuronal inhibition. |
false
(inhibits PREsynaptic release) |
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Which receptor excites/increase the CNS, and increases gastric acid and motility?
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M1
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T/F
M3 receptors increase secretions, relax smooth muscle, and increase NO/vasodilation. |
false
contracts smooth muscle |
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Nicotinic receptors require ______(#) Ach molecules to interact with receptor.
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2 Ach molecules
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Nicotinic receptors are stimulated by ________ and inhibited by _______ & ________.
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stim: nicotine
inh: curare & trimethaphan |
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There are ____ (#)-subunits on a nicotinic receptor and it works via a _____ channel.
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5
Na+ |
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Where does nicotinic receptors have 2 alpha-4 and 3 beta subunits?
a) muscle b) neural c) ganglia |
c) ganglia
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Muscarinic receptors have g-coupled proteins including
a) Gq b) Gs c) Gi d) a & b e) a & c f) all of the above |
e) a & c
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Muscarinic receptors are activated by _________ and inhibited by ________.
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activated: muscarine
inhibited: atropine |
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Which of the following is/are true about choline synthesis? Should have said acetylcholine synthesis
a. M2 presynaptic receptors inhibit activity of choline acetyltransferase b. Acetyl CoA comes from acetate that is taken back into terminals to be reutilized c. Acetylcholinesterase metabolizes any acetylcholine taken back into the neuron before it is put back into vesicles d. Choline must be actively taken up into terminals before synthesis e. All of the above are correct f. None of the above are correct |
d. Choline must be actively taken up into terminals before synthesis
or f. None of the above are correct |
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Acetylcholinesterase:
a. Circulates in plasma b. Is only found in tissues which contain muscarinic receptors c. Has a serine-histadine residue that binds the carboxyl terminal of acetylcholine d. Can be inhibited by exposure to elevated levels of acetylcholine e. All of the above are correct f. None of the above are correct |
c. Has a serine-histadine residue that binds the carboxyl terminal of acetylcholine
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Which of the following is/are true about cholinergic receptors?
a. M3 receptors are linked to Gq and use IP3 and DAG as second messengers b. Skeletal muscle nicotinic receptors contain only alpha and beta subunits c. Muscarinic receptors are easily desensitized by direct agonists d. Nicotinic receptors are only found in skeletal muscle and the ganglia e. All of the above are correct f. None of the above are correct |
a. M3 receptors are linked to Gq and use IP3 and DAG as second messengers
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Which of the following is/are true about direct cholinergic agonists?
a. Acetylcholine given orally could be used to treat a rapid heart rate b. Nicotine may cause tremors by direct action on presynaptic M2 receptors c. Arecholine has both nicotinic and muscarinic activity d. Bethanechol would cause urinary retention e. All of the above are correct f. None of the above are correct |
c. Arecholine has both nicotinic and muscarinic activity
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The toxicity of direct cholinergic agonists includes which of the following?
1. Dry mouth 2. Sweating 3. Urinary retention 4. Blurred vision A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
C = 2,4
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Pilocarpine
a. Is used mainly to treat urinary incontinence b. Has both nicotinic and muscarinic activity c. Is useful to treat rapid heart rates in hyperthyroid patients d. In overdose may cause tremors and convulsions e. All of the above are correct f. None of the above are correct |
f. None of the above are correct
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Physostigmine
a. Contains a carbonyl group that slowly dissociates from the esteratric site of acetylcholinesterase b. Is used therapeutically for COPD c. Directly stimulates M3 receptors d. Would rapidly reverse succinylcholine induced neuromuscular blockade e. All of the above are correct f. None of the above are correct |
a. Contains a carbonyl group that slowly dissociates from the esteratric site of acetylcholinesterase
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Which of the following is/are correct?
a. Physostigmine is the drug of choice for atropine poisoning because it crosses the blood brain barrier b. Neostigmine would be a better choice than Physostigmine to treat myasthenia gravis c. Pyridostigmine can prevent organophosphates from binding to acetylcholinesterase if taken before exposure d. Edrophonium has a short duration of action because it only binds to the anionic site e. All of the above are correct f. None of the above are correct |
e. All of the above are correct
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Which of the following is/are true?
a. Tacrine is the drug of choice for Alzheimer’s disease in patients with liver disease b. Donepezil produces significant nicotinic side effects c. Rivastigmine may cause hallucinations d. Edrophonium is useful in the diagnosis of Alzheimer’s disease e. All of the above are correct f. None of the above are correct |
c. Rivastigmine may cause hallucinations
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Which of the following is/are true about organophosphates?
1. They are resistant to Pralidoxime after aging 2. Nerve gases require metabolic activation 3. All undergo rapid transdermal absorption 4. Toxicity is due mainly to nicotinic effects A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
B = 1,3
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Which of the following is/are true?
a. Scopolamine – may cause amnesia b. Ipratropium – can effect M1 and M3 receptors c. Solifenacin – produces less dry mouth than Tolterodine d. Benztropin – selective for tremor in Parkinson’s disease e. All of the above are correct f. None of the above are correct |
e. All of the above are correct
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Therapeutic uses of atropine include which of the following?
1. Urinary retention 2. Dilate pupils 3. Increase GI motility 4. Reverse slow heart rate A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
C = 2,4
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Which of the following is/are true about ganglionic transmission?
a. Dopamine is responsible for the IPSP b. Acetylcholine acting on M1 receptors is responsible for the late slow EPSP c. Tubocurare does not affect ganglionic transmission d. Activation of M1 receptors is the major factor responsible for ganglionic transmission e. All of the above are correct f. None of the above are correct |
a. Dopamine is responsible for the IPSP
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Mecamylamine
a. Would cause salivation in a person at rest b. During mild exercise would increase sweating c. Would cause Miosis d. Would blunt the increase in cardiac output during exercise e. All of the above are correct f. None of the above are correct |
d. Would blunt the increase in cardiac output during exercise
or f. None of the above are correct |
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Succinylcholine
a. Effects can be reversed by Neostigmine b. Increases heart rate by direct blockade of M2 receptors c. Is the drug of choice for intubations in infants and children d. In individuals with a genetic variation in cholinesterase may significantly prolong recovery of muscle activity e. All of the above are correct f. None of the above are correct |
d. In individuals with a genetic variation in cholinesterase may significantly prolong recovery of muscle activity
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D-tubocurare
a. Causes significant potassium release b. Must always be used in combination with anesthetics during surgery c. Has both nicotinic and muscarinic antagonist activity d. May cause amnesia and hallucinations e. All of the above are correct f. None of the above are correct |
b. Must always be used in combination with anesthetics during surgery
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Which of the following is/are true?
a. Pancuronium produces more ganglionic blockade than tubocurare b. Doxacurium is the most potent neuromuscular blocker c. Order of potency for histamine release is Pancuronium > Doxacurium > Tubocurare d. Pancuronium has a shorter duration of action than tubocurare e. All of the above are correct f. None of the above are correct |
b. Doxacurium is the most potent neuromuscular blocker
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Parasympathetic activation would cause which of the following?
a) Negative inotropic effects b) Urinary retention c) Mydriasis d) Contraction of the radial muscle of the eye e) All of the above are correct f) None of the above are correct |
a) Negative inotropic effects
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Which of the following is/are true about acetylcholine synthesis?
a) Availability of Acetyl CoA is the rate limiting step in synthesis b) Choline acetyltransferase is found inside the vesicle c) Choline uptake occurs by simple diffusion d) Acetate is taken back up into the neuron and reused in ACH synthesis e) All of the above are correct f) None of the above are correct |
f) None of the above are correct
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Which of the following is/are true?
a) Acetylcholinesterase is found in the plasma b) Butyrlcholinesterase has a higher affinity for acetylcholine than acetylcholinesterase c) Alpha-bungarotoxin blocks nicotinic receptors while beta-bungarotoxin enhances ACH release d) Botulinum toxin works by interfering with the synthesis of ACH e) All of the above are correct f) None of the above are correct |
c) Alpha-bungarotoxin blocks nicotinic receptors while beta-bungarotoxin enhances ACH release
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Which of the following statements is/are correct?
a) Nicotinic receptors are linked to G-proteins Gi and Gq b) Nicotinic neuronal receptors have 5 subunits which include 2 alpha, 1 beta, 1 gamma, 1 delta c) M3 receptors are only found in peripheral tissues d) M2 receptors are the main cholinergic receptors in the heart e) All of the above are correct f) None of the above are correct |
d) M2 receptors are the main cholinergic receptors in the heart
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Carbachol
a) Is used to treat urinary incontinence b) Is more selective for muscarinic receptors than Bethanechol c) Is resistant to acetylcholinesterase d) Is a natural plant alkaloid e) All of the above are correct f) None of the above are correct |
c) Is resistant to acetylcholinesterase
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Which of the following is/are true about indirect acting agents?
a) They are the drugs of choice to reverse succinylcholine induced neuromuscular blockade b) They may be useful in atropine overdose c) They decrease fluid production in glaucoma d) All rapidly enter the CNS e) All of the above are correct f) None of the above are correct |
b) They may be useful in atropine overdose
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Which of the following therapeutic uses is/are correct?
a) Physostigmine – treat bradycardia b) Neostigmine – reverse CNS effects of atropine c) Edrophonium – urinary retention d) Pyridostigmine – myasthenia gravis e) All of the above are correct f) None of the above are correct |
d) Pyridostigmine – myasthenia gravis
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Which of the following combinations is/are correct?
a) Tacrine – long half life b) Donepezil – effective in the majority of patients c) Galantamine – selective for G1 isoform of ACHE enzyme d) Rivastigmine – use limited by nicotinic side effects e) All of the above are correct f) None of the above are correct |
b) Donepezil – effective in the majority of patients
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Organophosphates
1) Are resistant to pralidoxime after undergoing aging process 2) Rapidly enter the CNS 3) Insecticides require metabolic activation 4) Toxicity is mainly due to muscarinic effects A = 1,2 3 are correct B = 1 and 3 are correct C = 2 and 4 are correct D = 4 only is correct E = All of the above are correct F = None of the above are correct |
A = 1,2 3 are correct
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Muscarinic antagonists would cause which of the following?
a) Blurred vision b) Bronchoconstriction c) Increased temperature d) Ataxia due to muscle weakness e) All of the above are correct f) A and C are correct |
f) A and C are correct
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Atropine overdose would cause which of the following?
1) Delirium 2) Bradycardia 3) Constipation 4) Salivation A = 1,2 3 are correct B = 1 and 3 are correct C = 2 and 4 are correct D = 4 only is correct E = All of the above are correct F = None of the above are correct |
B = 1 and 3 are correct
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Scopolomine
a) Is effective at both muscarinic and nicotinic receptors b) Does not cross the blood brain barrier c) Would be useful in Alzheimer’s disease d) Acts at M3 receptors in the chemoreceptor trigger zone and vomiting center e) All of the above are correct f) None of the above are correct |
d) Acts at M3 receptors in the chemoreceptor trigger zone and vomiting center
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Tiotropium
a) Is used in urinary incontinence b) Rapidly crosses the blood brain barrier c) Is selective for M3 receptors d) Is less active than atropine on bronchial cilia e) All of the above are correct f) None of the above are correct |
d) Is less active than atropine on bronchial cilia
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14) Which of the following is/are true?
a) Tolterodine is an antagonist at muscarinic receptors b) Oxybutynin relaxes the bladder and contracts the urinary sphincter c) Solifenacin is metabolized by CYP 3A4 d) Solifenacin is selective for M3 receptors e) All of the above are correct f) None of the above are correct |
e) All of the above are correct
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Which of the following is/are true about ganglionic transmission?
a) d-Tubocurare can block the ganglionic nicotinic receptor b) Dopamine is responsible for the late slow EPSP in the ganglia c) Acetylcholine acting at M1 receptors is responsible for the slow EPSP d) Peptide released from the presynaptic terminal causes the IPSP e) None of the above are correct f) A and C are correct |
f) A and C are correct
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Which of the following is/are correct?
a) Nicotine, initially would enhance activity of sympathetic nerves in blood vessels b) With higher doses nicotine would initially stimulate then block GI motility c) Mecamylamine would lead to urinary retention d) Mecamylamine would cause dry mouth e) All of the above are correct f) None of the above are correct |
e) All of the above are correct
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Which of the following is/are true about neuromuscular blockers?
a) They bind the beta subunit of the nicotinic receptor b) Pancuronium causes more histamine release than tubocurare c) Doxacurium causes less ganglionic blockade than Pancuronium d) Tubocurare has a short duration of action e) All of the above are correct f) None of the above are correct |
c) Doxacurium causes less ganglionic blockade than Pancuronium
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Succinylcholine
a) Effects would be potentiated by Physostigmine b) May cause muscle fasciculation’s c) Infants are less sensitive to actions d) May in combination with gaseous anesthetics cause malignant hyperthermia e) All of the above are correct f) None of the above are correct |
e) All of the above are correct
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D-tubocurarine
a) May cause delirium and hallucinations b) Actions are reversed with Physostigmine c) Is more potent than Pancuronium d) Is not effective infants e) All of the above are correct f) None of the above are correct |
b) Actions are reversed with Physostigmine
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Parasympathetic activation would cause which of the following?
a) Decreased urination b) Decreased bronchiolar secretions c) Nervous sweating d) Loss of accommodation e) All of the above f) None of the above |
f) None of the above
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Which of the following is/are true?
a) Acetylcholine preferentially acts on muscarinic receptors b) Acetylcholinesterase is found primarily on the outside of the presynaptic membrane c) Acetylcholine is taken back up into the nerve terminal and repackaged in vesicles d) Acetylcholinesterase is found in both blood and tissues e) All of the above are correct f) None of the above are correct |
f) None of the above are correct
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Which of the following drug-mechanisms is/are correct?
a) Botulinum toxin – flaccid paralysis due to decreased ACH release b) Hemicholinium – Increased muscle contraction due to enhanced ACH synthesis and release c) Black widow spider venom – contracted paralysis due to inhibition of ACH metabolism d) alpha-bungarotoxin – flaccid muscle paralysis due to depolarization blockade e) All of the above are correct f) None of the above are correct |
a) Botulinum toxin – flaccid paralysis due to decreased ACH release
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Which of the following is/are correct about cholinergic receptors?
a) Nicotinic neuronal receptors contain only alpha and beta subunits b) M1 receptor activation increases IP3 and DAG c) M 2 receptors are found mainly in the heart and are the muscarinic autoreceptors d) M3 receptors increase smooth muscle contraction and increase secretions. e) All of the above are correct f) None of the above are correct |
e) All of the above are correct
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Nicotine
1) Selectively activates neuronal nicotinic receptors 2) Binds to the alpha subunit of the receptor 3) With chronic use directly inhibits the chemoreceptor trigger zone 4) May cause convulsions A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
C = 2,4
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Carbachol
a) Is rapidly metabolized by ACHE b) Indirectly activates nicotinic and muscarinic receptors c) Stretches trabecular meshwork in the eye to increase aqueous fluid outflow d) Does not affect accommodation e) All of the above are correct f) None of the above are correct |
c) Stretches trabecular meshwork in the eye to increase aqueous fluid outflow
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Bethanacol
a) Activates both parasympathetic and sympathetic ganglia b) Is useful after bladder surgery c) Is a natural plant alkaloid d) Is frequently used in glaucoma e) All of the above are correct f) None of the above are correct |
b) Is useful after bladder surgery
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Pilocarpine
1) Is useful to stimulate salivation 2) Is contraindicated in myocardial ischemia 3) Is effective in glaucoma 4) Is useful in peptic ulcer disease to increase GI motility to move acid more quickly through the bowel A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
A = 1,2,3
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Which of the following is/are true about indirect cholinergic agonists?
a) They increase the release of ACH from nerve terminals b) Are all readily reversible c) Are the treatment of choice for succinylcholine overdose d) Slow the progression of myasthenia gravis e) All of the above are correct f) None of the above are correct |
f) None of the above are correct
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Which of the following is/are correct?
a) Physostigmine may cause tachycardia and prevent sweating b) Neostigmine is the drug of choice to reverse atropine poisoning c) Pyridostigmine rapidly reverses organophosphate binding to ACHE d) Neostigmine can reverse tubocurarine induced muscle paralysis e) All of the above are correct f) None of the above are correct |
d) Neostigmine can reverse tubocurarine induced muscle paralysis
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Which of the following is/are correct?
a) Tacrine enters the CNS and directly activates cholinergic receptors b) Galantamine irreversibly inhibits ACHE c) Donepezil may cause hepatotoxcicity d) Rivastigmine selectively blocks the brain isoform of ACHE e) All of the above are correct f) None of the above are correct |
d) Rivastigmine selectively blocks the brain isoform of ACHE
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Which of the following is/are true about organophosphates?
1) They show poor transdermal absorption 2) Their effects are rapidly reversed by pralidoxime 3) All require metabolic activation 4) May induce depolarization blockade of skeletal muscle A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
D = 4 only
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A muscarinic antagonist would cause which of the following?
a) Miosis b) Urinary retention c) Increased inotropic effects on the heart d) Muscle weakness e) All of the above are correct f) None of the above are correct |
b) Urinary retention
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Atropine
a) Has both nicotinic and muscarinic activity b) Would decrease heart rate c) Pretreatment in a patient, who is then given Norepinephrine would develop tachycardia d) Directly alters the temperature control center in the hypothalamus e) All of the above are correct f) None of the above are correct |
c) Pretreatment in a patient, who is then given Norepinephrine would develop tachycardia
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Scopolamine
a) Is an effective prophylactic for motion sickness b) May cause mydriasis c) May cause amnesia d) May cause CNS depression e) All of the above are correct f) None of the above are correct |
e) All of the above are correct
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Ipratropium
a) May cause amnesia b) Is a general smooth muscle relaxant c) Selective for M3 receptors d) May be used in acute asthma e) All of the above are correct f) None of the above are correct |
f) None of the above are correct
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Which of the following is/are true?
a) Tolterodine is a selective M1 antagonist b) Oxybutynin may cause dry mouth and dry eyes c) Tolterodine may cause diarrhea d) Solifenacin is a nonselective muscarinic antagonist e) All of the above are correct f) None of the above are correct |
b) Oxybutynin may cause dry mouth and dry eyes
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Mecamylamine would cause which of the following?
a) Urination b) Miosis c) Salivation d) Inhibit ejaculation in males e) All of the above are correct f) None of the above are correct |
d) Inhibit ejaculation in males
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Succinlycholine
1) Is rapidly metabolized by ACHE 2) Briefly activate then blocks nicotinic receptors 3) May cause tachycardia 4) Toxicity can be reversed by Physostigmine A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
A = 1,2,3
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Succinylcholine
a) Toxicity may include hypotension and brochospasm due to increased potassium release b) Is the drug of choice for intubations in patients with sever burns c) Is the drug of choice for muscle relaxation in infants d) Duration of action may be increased in individuals with abnormal ACHE enzyme e) All of the above are correct f) None of the above are correct |
d) Duration of action may be increased in individuals with abnormal ACHE enzyme
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d-Tubocurarine
a) Must be given by infusion because of short duration of action b) Is a reversible nicotinic antagonist c) Is a potent analgesic d) Is not effective in newborns e) All of the above are correct f) None of the above are correct |
b) Is a reversible nicotinic antagonist
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Which of the following is/are true of neuromuscular blockers?
a) Order of potency for neuromuscular blockade is Pancuronium > Doxacurium > tubocurarine b) Order of potency for ganglionic blockade is Doxacurium > Tubocurarine > Pancuronium c) Order of potency for histamine release is tubocurarine > Doxacurium > Pancuronium d) Doxacurium has the longest duration of action e) All of the above are correct f) None of the above are correct |
c) Order of potency for histamine release is tubocurarine > Doxacurium > Pancuronium
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Atropine would increase / decrease pupil size, increase / decrease GI secretions, increase / decrease body temperature, relax / contract ciliary muscle
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increase
decrease increase relax |
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The enzyme that converts choline and acetyl Co A into acetylcholine is ____________.
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Choline acetyl transferase
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Skeletal muscle Nicotinic cholinergic receptors are made up if which subunits
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2 alpha, 1 beta, 1 gamma, 1 delta
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List 4 of the general toxicities of muscarinic agonists
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salivation, lacrimation, urination, defication, sweating, miosis, bradycardia
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List two therapeutic uses of Carbachol ______________ and ____________.
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stimulate bladder, stimulate GI tract, also Glaucoma, Miosis
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List an ACHE (should have said inhibitor) used in Alzheimer’s disease and an antagonist used in overactive bladder
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Tacrine, Donepezil, Galantamine, Rivastigmine and Tolterodine, Oxybutynin, Solafencin, Darifeacin
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The drug that blocks choline uptake into the nerve terminal is
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Hemicholinium
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Parasympathetic activity would increase / decrease heart rate, increase / decrease GI motility, increase / decrease urination, relax / contract sphincters
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decrease
increase increase relax |
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Choline acetyltransferase converts _________ and ___________ into acetylcholine
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Choline and AcetylCoA
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Neuronal Nicotinic cholinergic receptors are made up if which subunits __________
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2 alpha and 3 beta
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List 4 of the general toxicities of atropine
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mydriasis, blurred vision, tachycardia, urinary retention, ataxia, hallucinations, delirium
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List two therapeutic uses of Neostigmine
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GI stimulation, Urinary retention, myasthenia gravis, reverse neuromuscular blockade (any two)
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List an agent that blocks acetylcholine release ________, and an agent that enhances acetylcholine release _________.
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Botulinum toxin, or metacholine or MG++
beta bungarotoxin or black widow spider venom |
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The process by which an organophosphate become permanently bound to the ACHE enzyme is called
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Aging
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Which of the following is/are correct?
a) Choline acetyl transferase (CAT) breaks acetylcholine down into acetate and choline b) Choline is taken up into vesicles before it is converted into acetylcholine c) Acetycholine release is quantal d) M1 type muscarinic receptors are the autoreceptor on acetylcholine neurons e) All of the above are correct. f) None of the above are correct |
c) Acetycholine release is quantal
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Acetylcholinesterase
a) Has both an ionic and esteratic binding site b) Is the fastest enzyme c) Is found in red blood cells, nerves and muscle d) Is found in all ganglia e) All of the above are correct f) None of the above is correct |
e) All of the above are correct
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Which of the following combinations is/are correct?
a) Botulinus toxin – enhance ACH release b) Hemicholinium - blocks choline uptake c) Beta-bungarotoxin - blocks nicotinic receptors d) Black widow spider venom - blocks ACH release e) All of the above are correct f) None of the above correct |
b) Hemicholinium - blocks choline uptake
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Nicotinic receptors:
1) Require 2 alpha subunits for ACH binding 2) Have multiple combinations of subunits 3) Can be desensitized by long exposure to ACH 4) Are linked to Gi and decrease cAMP A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
A = 1,2,3
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Muscarinic receptors
a) Are coupled to Gi and Gq b) Are all competitively blocked by muscarine c) Are easily desensitized by ACH d) Are made up of 5 membrane spanning units e) All of the above are correct f) None of the above are correct |
a) Are coupled to Gi and Gq
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Carbachol
a) Is rapidly broken down by acetylcholinesterase b) Contracts radial muscle of eye to cause miosis c) Used for urinary incontinence d) Has both nicotinic and muscarinic effects e) All of the above are correct f) None of the above are correct |
d) Has both nicotinic and muscarinic effects
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Contraindications for direct cholinergic agonists could include:
1) COPD 2) Bradycardia 3) GERD 4) Myocardial ischemia A = 1,2,3 B = 1,3 C = 2,4 D = 4 only E = All of the above are correct F = None of the above are correct |
E = All of the above are correct
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The therapeutic indications for indirect cholinergic agonists include:
a) Urinary incontinence b) Alzheimer’s disease c) COPD d) Paralytic ileus e) All of the above are correct f) B and D are correct |
f) B and D are correct
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Which of the following is/are correct?
a)Neostigmine could be used to reverse scopolamine induced amnesia b)Pyridostigmine can be used to reverse Succinylcholine induced muscle paralysis c)Physostigmine can be used to reverse atropine toxicity d)Edrophonium can effectively treat myasthenia gravis e)All of the above are correct f)None of the above are correct |
c)Physostigmine can be used to reverse atropine toxicity
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Which of the following is/are correct?
a) Tacrine – may cause Hepatotoxicity b) Donepezil – may slightly slow progression of Alzheimer’s disease c) Galantamine – may cause drowsiness d) Rivastigmine – selective for G1 isoform of ACHE e) All of the above are correct f) None of the above are correct |
e) All of the above are correct
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Organophosphates show which of the following characteristics?
a) Transdemal absorption b) Reversibly bind to nicotinic receptors c) High lipid solubility d) Poisoning is easily reversed with atropine e) A and C f) B and D |
e) A and C
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Atropine indications include:
a) Bradycardia b) Glaucoma c) Urinary retention d) After intestinal surgery e) All of the above are correct f) None of the above are correct |
a) Bradycardia
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Which of the following is/are correct?
a) Scopolamine – prophylaxis of motion sickness b) Ipratropium – doesn’t crosses blood brain barrier c) Tolteridine – may cause significant dry mouth d) Benztropin – may cause CNS excitation e) All of the above are correct f) None of the above are correct |
e) All of the above are correct
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During exercise, ganglionic blockade would cause the following?
1) Urinary retention 2) Reduced sweating 3) Dry mouth 4) Tachycardia A = 1,2,3 B = 1,3 C = 2,3 D = 4 only E = All of the above are correct F = None of the above are correct |
A = 1,2,3
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Tubocurare
a) Is a potent anesthetic b) Easily crosses the blood brain barrier c) Has a long duration of action d) Is easily reversed by physostigmine e) All of the above are correct f) None of the above are correct |
d) Is easily reversed by physostigmine
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Which of the following combinations is/are correct?
a) Nicotinic neuromuscular receptors – blocked by Hexamethonium b) M1 muscarinic receptors – Increase IP3 and DAG c) M2 muscarinic receptors - Affect Gs and increase cAMP d) M3 muscarinic receptors - Excite CNS e) M4 muscarinic receptors – Contract smooth muscle f) M5 muscarinic receptors – Found in ganglia and paracrine cells |
b) M1 muscarinic receptors – Increase IP3 and DAG
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Which of the following is/are true?
a. Pancuronium has potent anesthetic activity b. Curare overdose can be treated effectively with physostigmine c. Doxacurium is more potent and causes more histamine release than curare d. Curare is a nicotinic receptor antagonist e. A and C are correct f. B and D are correct |
f. B and D are correct
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Succinylcholine
1. May cause potassium release 2. Is less effective in infants than curare 3. Is a good choice for a muscle relaxant when setting bone fractures 4. An overdose can be treated with neostigmine a = 1,2,3 are correct b = 1 and 3 are correct c = 2 and 4 are correct d = 4 only is correct e = All are correct f = None are correct |
a = 1,2,3 are correct
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Ganglionic transmission
a. The EPSP is mainly due to actions on muscarinic receptors b. Dopamine agonists would enhance ganglionic transmission c. Slow EPSP’s and late slow EPSP’s decrease ganglionic transmission d. At rest ganglionic blockade would cause tachycardia e. All of the above are correct f. None of the above are correct |
d. At rest ganglionic blockade would cause tachycardia
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Which of the following is/are true?
a. Tolteradine blocks M2 receptors in the bladder b. Ipratropium is preferred to atropine in COPD because of fewer effects on cilia c. Oxybutynin is useful therapy in paralytic ileus d. Pirenzipine prevents histamine induced gastric acid secretion from parietal cells e. All of the above are correct f. None of the above are correct |
b. Ipratropium is preferred to atropine in COPD because of fewer effects on cilia
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Atropine
1. Overdose can be treated with Succinylcholine 2. Causes mydriasis by blocking radial muscle of eye 3. Could cause GI hypermotility 4. Causes Bradycardia by blocking M2 receptors a = 1,2,3 are correct b = 1 and 3 are correct c = 2 and 4 are correct d = 4 only is correct e = All are correct f = None are correct |
f = None are correct
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Bethanechol would cause which of the following?
a. Sweating b. Mydriasis c. Urinary retention d. Ejaculation in males e. All of the above are correct f. None of the above are correct |
a. Sweating
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Which of the following is/are true about muscarinic receptors?
1. They are coupled to Gi and Gq 2. M1 receptors are mainly in the CNS, ganglia and paracrine cells 3. M3 receptors use IP3 and DAG as second messengers 4. Can undergo depolarization blockade with increased Acetylcholine levels a = 1,2,3 are correct b = 1 and 3 are correct c = 2 and 4 are correct d = 4 only is correct e = All are correct f = None are correct |
a = 1,2,3 are correct
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Which of the following is/are true?
a. Nicotine may cause convulsions through activation of M1 receptors b. Carbachol is a selective muscarinic agonist c. Pilocarpine is contraindicated in hyperthyroid patients d. Bethanechol is used mainly to decrease GI muscle activity during abdominal surgery e. All of the above are correct f. None of the above are correct |
c. Pilocarpine is contraindicated in hyperthyroid patients
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Indirect cholinergic agonists are used for which of the following?
1. Stimulate intestinal activity after surgery 2. Organophosphate poisoning antidote 3. Glaucoma 4. Urinary Incontinence a = 1,2,3 are correct b = 1 and 3 are correct c = 2 and 4 are correct d = 4 only is correct e = All are correct f = None are correct |
a = 1,2,3 are correct
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Scopolamine
a. Is used to enhance GI motility b. Causes CNS excitation c. Interferes with short term memory d. Causes miosis e. All of the above are correct f. None of the above are correct |
c. Interferes with short term memory
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Organophosphate poisoning could cause which of the following symptoms?
a. Muscle twitches b. Constipation c. Thick viscous salivation d. Increased body temperature e. A and C are correct f. B and D are correct |
a. Muscle twitches
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Stimulation of nicotinic receptors would cause:
1. Norepinephrine release from adrenal medulla 2. Contract skeletal muscle 3. Stimulate ganglia 4. Profuse sweating a = 1,2,3 are correct b = 1 and 3 are correct c = 2 and 4 are correct d = 4 only is correct e = All are correct f = None are correct |
a = 1,2,3 are correct
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Which of the following would be seen in an atropine overdose?
1. Bronchodilation 2. Salivation 3, Constipation 4. Bradycardia a = 1,2,3 are correct b = 1 and 3 are correct c = 2 and 4 are correct d = 4 only is correct e = All are correct f = None are correct |
b = 1 and 3 are correct
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In patients with organophosphate poisoning pralidoxime (2-PAM) is effective because?
a. It antagonizes acetylcholine at muscarinic receptors b. It antagonizes acetylcholine at nicotinic receptors c. Inactivates acetylcholine d. Increases organophosphate excretion e. Reactivates acetylcholinesterase f None of the above are correct |
e. Reactivates acetylcholinesterase
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Botulimum toxin
a. Blocks nicotinic receptors b. Toxicity can be treated with atropine c. Can cause diarrhea d. Blocks acetylcholine release e. All of the above are correct f. None of the above are correct |
d. Blocks acetylcholine release
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Matching
Cycloplegia a. Atropine b. Benztropin c. Donepezil d. Edrophonium e. Galantamine f. Mecamylamine g. Pancuronium h. Physostigmine i. Rivastigmine j. Scopolamine |
a. Atropine
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Matching
Ganglionic blocker a. Atropine b. Benztropin c. Donepezil d. Edrophonium e. Galantamine f. Mecamylamine g. Pancuronium h. Physostigmine i. Rivastigmine j. Scopolamine |
f. Mecamylamine
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Matching
Neuromuscular blocker that may cause tachycardia a. Atropine b. Benztropin c. Donepezil d. Edrophonium e. Galantamine f. Mecamylamine g. Pancuronium h. Physostigmine i. Rivastigmine j. Scopolamine |
e. Galantamine
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Matching
Diagnosis of myasthenia gravis a. Atropine b. Benztropin c. Donepezil d. Edrophonium e. Galantamine f. Mecamylamine g. Pancuronium h. Physostigmine i. Rivastigmine j. Scopolamine |
d. Edrophonium
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Matching
Tremor in Parkinsons’s disease a. Atropine b. Benztropin c. Donepezil d. Edrophonium e. Galantamine f. Mecamylamine g. Pancuronium h. Physostigmine i. Rivastigmine j. Scopolamine |
b. Benztropin
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Matching
Selective for the G1 isoform of ACHE a. Atropine b. Benztropin c. Donepezil d. Edrophonium e. Galantamine f. Mecamylamine g. Pancuronium h. Physostigmine i. Rivastigmine j. Scopolamine |
i. Rivastigmine
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Matching
May slow progression of Alzheimer’s disease. a. Atropine b. Benztropin c. Donepezil d. Edrophonium e. Galantamine f. Mecamylamine g. Pancuronium h. Physostigmine i. Rivastigmine j. Scopolamine |
c. Donepezil
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